It is now somewhat over 20 years since the original description of regional ileitis as a clinical and a pathological entity.1 Sufficient time has elapsed to allow for the gathering of data on a large scale, for maturing thoughts and experiences, and for a more critical analysis of the various aspects of this disease. Originating with a description of 14 cases of ileitis involving only the terminal segment of the small bowel, our personal files now contain 562 cases of nonspecific granulomatous enteritis involving distal ileum, ileum and jejunum, duodenum, and probably (although rarely) the stomach. In the course of these 20 or more years, much interest has centered on the development of our concepts of benign inflammatory diseases of the intestinal tract. Ulcerative colitis alone had been described and was recognized in its distal or its universal type since the description in 1875 by Wilks. It was later styled by Schmidt as colitis gravis. In 1930,2 a segmental or right-sided colitis, in¬ volving the ascending colon with extension distally, was differentiated from the much commoner left-sided ulcer¬ ative colitis. In 1932, the clinical picture of terminal ileitis as a regional phenomenon attracted attention to this segment of the small intestine. In 1934, Brown, Bargen, and Weber 3 extended the concept of regional ileitis to include some or all of the ileum and jejunum under the term "regional enteritis." In recent years, involvement of the duodenum and possibly the stomach * has extended our concept to include all of the intestinal tract within the confines of nonspecific inflammatory diseases. Unfor¬ tunately these clear-cut concepts are confused by the fur¬ ther occurrence of mixed forms of ileitis and colitis, or ileocolitis, representing dual entities in which both large and small intestine are involved. The disease in each seg¬ ment runs its individual course and creates its own com¬ plications.That the disease now known as regional ileitis or en¬ teritis is not entirely new is attested to by the fact that in the older literature occasional cases with autopsy findings had been described as single rare examples by Morgagni, by Abercrombie, and by Combe and Saunders, even though any resemblance of these cases to real regional ileitis is purely conjectural. However, iso¬ lated, nonspecific granulomas of segments of the entire alimentary canal had been described by many authors in the post-Virchow period of intensive study of gross and cellular pathology.Was regional ileitis, as originally described, an accu¬ rate picture of a new clinical and pathological entity? As a clinical picture, yes, for even today the original nota¬ tions as to symptoms, complications, fistulas, and course have been but little amended. For the condition as a pathological entity, singular and discrete, the evidence is perhaps less convincing. Although the peculiar lym¬ phatic blockage, intense follicular regeneration, and miliary-like tubercles with giant cell system formation are strictly characteristic of enteritis involving the term...
